Biomedical Computing: Digitizing Life in the United States by Joseph November (review)

Joseph November's Biomedical Computing: Digitizing Life in the United States is concerned with the intellectual, institutional, and social forces that supported efforts to enable biology and medicine's objects of study to be transformed "from exemplars of systems that computers could not describe into exemplars of systems that computers could indeed describe" (p. 7). He argues that the origins of digital computing, more broadly, has its roots in biomedicine and the opportunities and constraints provided by the US National Institutes of Health (NIH).

As November notes in a concise bibliographic essay, historians of computing have had little to say about biology and even less about medicine. This is remarkable considering the ubiquity of computers in the lab as well as the clinic. In his lucid telling, the history of computing and the history of biomedical science are inextricably linked.

This reworking of the history of computing begins in the 1940s to show how operations research (OR) provided a mathematized channel for the importation of computers into biology and medicine. Robert S. Ledley, a dentist-turned OR computer specialist, and Lee B. Lusted, a radiologist with a background in radar engineering, set out to optimize the clinical encounter by trying and not quite succeeding to digitize patient screening across the country.

November then looks at debates at the NIH in the 1950s and 1960s over how to promote computer use among biomedical researchers. Members of the newly created Advisory Committee on Computers and Research (ACCR) at the NIH were dismayed to realize that many biologists were relatively uninterested. Ledley sought to change this, arguing that it would be crucial to reform the life sciences such that they could be made amenable to computers. This would mean mathematizing data processing as well as discouraging the individualistic, small-scale approach that characterized biological research.

In the following chapter, "The Forgotten Biomedical Origins of Personal Computing," November revisits the history of LINC, now recognized as the first personal computer. Wesley Clark, LINC's steward, took a different tack than Ledley and Lusted. Rather than changing biologists to meet the needs of computers, he sought to transform computers to meet the need of biologists. Clark felt they needed a computer that they could use without the help of intermediaries. The real-time computing capacities of LINC, as well its visual interface and small scale, would prove critical. NIH agreed to support a training camp where biologists could learn how to use LINC, which gradually gave them the confidence to take the machine back to their labs.

The next chapter looks at what happened when they did so, focusing on the use and development of NIH-sponsored computers, especially LINC, in laboratories and hospitals. It is here the reader gets a view of the opinions and experiences of biologists and clinicians themselves, and it becomes clear that biology and medicine were each very differently oriented toward computers. In the realm of biology, for instance, demand for computers was stoked by outside actors: first the NIH and then computer manufacturers. November demonstrates the missionary zeal with which the latter group descended upon biologists, including an amusing discussion of a role-playing exercise between "John Q. Scientist" and a Digital Equipment salesman peddling LINC-style computers.

The situation was different in the clinic, where there was a need to handle much greater amounts of data and to do so more reliably. In one of the most telling chapters—which could well be expanded into a book of its own—November sketches the roadblocks that computing faced in the realm of clinical care. We learn about NIH's support of an elaborate but impersonal patient screening system developed for Kaiser Permanente. We also learn about Massachusetts General Hospital's attempts to integrate biomedical research and clinical care through the digitization of patient records. November concludes that the same NIH policies intended to encourage hospitals to adopt computers ended up hindering their uptake, largely because they failed to provide means for hospitals to use computers to...